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The Department of Health and the National Health Service (NHS) Future Focused Finance (FFF) programme promotes effective engagement between clinical and finance staff. Surveys undertaken by the Department of Health between 2013 and 2015 found few NHS Trusts reported high levels of engagement. The purpose of this paper is to gain a better understanding of current working relationships between NHS clinical and finance professionals and how they might be supported to become more effective.

Ipsos MORI were commissioned by the NHS FFF programme to undertake an online survey of NHS clinical and finance staff between June and August 2015.

The majority of clinicians had a member of a finance team linked to their speciality or directorate. Clinical and finance professionals have a positive view of joint working preferring face-to-face contact. Clinician’s confidence in their understanding of finance was generally good and finance staff felt they had a good understanding of clinical issues. Effective working relationships were facilitated by face-to-face contact, a professional relationship, and the availability of clear, well presented finance and activity data.

Data protection issues limited the accessibility of the survey team to NHS staff resulting in a relatively low-response rate. Other forms of communication, including social media, were utilised to increase access to the survey.

The FFF programme is a unique programme aimed at making the NHS finance profession fit for the future. The close partnering work stream brings together the finance and clinical perspective to share knowledge, evidence, training, and to develop good practice and engagement.

This paper examines the historical background of accountingization, colonization and hybridization in the health services by exploring the relationship between hospital accounting and clinical medicine in Britain between the late 1960s and the early 2000s.

The paper draws on an analysis of professional journals, government reports and other documentary sources relating to accounting and medical developments. It is informed by Abbott's sociology of professions and Eyal's sociology of expertise.

The paper shows that not only accountants but also elements within the medical profession sought to make the practice of medicine more visible, calculable and standardized, and that accounting and medical attempts to make medicine calculable interacted in a mutually reinforcing manner. Consequently, it argues that a movement towards clinical forms of quantification within the medical profession made it more open to economic calculation, which underpinned hospital accounting reforms and the accountingization, colonization or hybridization of health services.

The paper demonstrates that a fuller understanding of the relationship between accounting and public sector professions can be developed if we examine their mutual interactions rather than restricting ourselves to analyzing accounting's effects on public sector professions. The paper moreover illustrates instances of intraprofessional conflict and inter-professional cooperation, and draws on the sociology of expertise to suggests that while hospital accounting reforms have curbed the power of medical professionals, they have also enhanced the power of clinical expertise.

This paper aims to analyse the role of communication in shaping the mechanisms of accountability routines.

Conceptual elements of the theory of communicative action and the literature on routines were used to conduct a field study in two hospital districts in Finland, from 2009 to 2015. Data were based on interviews, document analysis, observed meetings and repeated contact with key informants.

The findings explain how accountability routines take different forms – weak or strong – in different organisations and at different hierarchical levels. Differences depend on the generative structures and mechanisms of the communicative process – relational and normative – used to give and ask information to and from organisation members involved in accountability relationships. An explorative finding is that discourse-based communication plays an important role in bridging the gap between weak and strong accountability routines. The main theoretical contribution is to conceptualise and show the role of communicative rationalities in shaping the mechanisms of accountability routines.

The implication for practitioners and policymakers is to show to what extent the organisation policies and communicative rationalities used in accountability have potential to improve or not to improve the practices of accountability routines. Mutual understanding, motivation and capacity of organisation members to do as expected and agreed upon without pressure improve accountability routines.

The value of this study is to explain how accountability routines take different forms in practice (weak or strong) in different organisations and at different hierarchical levels, depending on the generative structures of the communicative process used in practicing accountability routines.

The purpose of this paper is to bring the discussion on the relationship between management and medicine a step forward by focussing on: first, how the notion of hybrid and hybridity has been used in the literature on healthcare management. Second, the authors have mapped the alternative ways that the concept have been used in order to conceptualize a more specific set of possible combinations of managerial and professional roles in healthcare management. Hybrid management is a topic that ought to be important for training, communication among researchers and for identifying areas of future research: in management, in healthcare reforms, in sociology of professions and in theory of organizations.

The authors provide a systematic literature review in order to map the various conceptualizations of hybrid management. The authors have searched for “hybrid leadership,” “hybrid management” combined with hospitals and health care in a whole range of journals, identified in Google scholar, Academic Search Premier, Academic Research Library and Sage Publication. The authors have also used already existing literature reviews. The search has resulted in more than 60 articles and book titles that have been classified according to whether they make a fit with three alternative ways of conceptualizing hybrid management. The authors are aware that they might have missed some relevant literature but the literature included is quite comprehensive.

In the literature the authors have found three conceptualizations of management. The clinical manager who combines professional self-governance with a general management logic. The commercialized manager who combines professional self-governance with an enterprise logic. The neo-bureaucratic manager who combines self-governance with a neo-bureaucratic logic.

In most analyses of hybridity in management and organization the notion of hybrid has been used in a rather superficial way. By mapping the various uses of hybrid in the literature and suggest how a professional logic may be combined with a set of alternative logics of management the authors provide a platform for developing the concept of hybrid management into a more useful tool for analyses of changes in healthcare management.

Examines the issue of involving clinicians in management and the management processes. Considers the effect of the changing context of practice and the pressures that are imposed on the medical profession by this involvement.

This study aims to investigate the hybridization practices that medical managers engage with to promote accounting and performance measurement in the hybrid setting of healthcare. In doing so, the authors explore how medical managers enact and become practitioners of hybridity.

The authors adopt a practice lens to conceptualize hybridization as an emergent, situated practice and capture the micro-activities that medical managers engage with when they enact hybridity. The authors conducted semi-structured interviews with medical managers, business managers and coding professionals and collected documents at an English National Health Service (NHS) hospital over the course of five years.

The findings accentuate two emergent practices through which medical managers instill hybridity to individuals who are hesitant or resistant to hybridization. Medical managers engage in equivocalizing and de-stigmatizing practices to broaden the understandings, further diversify or reconcile the teleologies of clinicians in non-managerial roles. In doing so, the authors signal the merits of accounting in improving care outcomes and remove the stigma associated to clinical engagement with costs.

The study contributes to hybridization and practice theory literature via capturing how hybridity is enacted in practice in a healthcare setting. As medical managers engage with and promote accounting information and performance measurement technologies in their practice environment, they transcend professional boundaries and hybridize the professional spaces that surround them.

The purpose of this paper is to investigate the intricate ways in which accounting is implicated in the unfolding of strategizing in a pluralistic setting. The authors treat strategizing as a practical coping mechanism which begins in response to a problem and unfolds over time into an episode. This approach enables the authors to explore strategizing pathways and the ways they can mobilise accounting to advance from practical coping to explicit strategic intent.

The authors conducted semi-structured interviews with Clinical Directors, Business Managers and Finance personnel at three NHS hospitals. Documents were also collected, such as business cases and financial reports. The authors employed theories on strategizing agency, episodes and practical coping to select examples of strategizing and indicate how strategizing is constructed and performed. The authors present the results of this qualitative analysis in three strategizing narratives.

The analysis highlights how Clinical Directors’ strategizing with accounting, in response to their financial problems, can take on contesting, conforming and circumventing modes. As the strategizing pathway unfolds, accounting acts as an obligatory passage point through which Clinical Directors pursue their strategic intent. Along each pathway the authors identify, first, where practical coping takes on a clear strategic intent and, second, whether this emergent strategy proves efficacious.

The authors contribute to the nascent body of accounting and strategizing studies through seeing strategizing with accounting, not as the formulation of explicit organisational strategy as “done” in board rooms and strategy meetings, but as an impromptu response to a critical financial problem within a localised organisational setting. In response to a problem, actors may realise their immanent strategizing through their engagement with accounting practices.

This paper aims to identify variation in the introduction of New Public Management reforms in healthcare and how this variation is related to country‐specific healthcare states.

The analysis uses the introduction of clinical standards in Britain and Germany as cases. The two countries are characterised by interesting differences in relation to the institutional set‐up of healthcare states and as such present ideal cases to explore the specific ways of how healthcare states filter clinical standards as tools of a generic managerialism.

Both countries have introduced clinical standards but, importantly, the substantive nature of clinical standards differs, reflecting differences in initial institutional conditions. More specifically, in Britain clinical standards have taken the form of two parallel policies, which strengthen hierarchy‐based governing and redefine professional self‐regulation. In Germany, by contrast, clinical standards come in one single policy, which strengthens the hybrid of network‐ and hierarchy‐based governing and to some extent also pure hierarchy‐based forms of governing.

First, with its cross‐country comparative focus, the analysis is able to identify systematic variations across healthcare states and the specific ways in which they impact on the introduction of New Public Management. Second, with its focus on clinical standards, the analysis deals with the governance of medical practice as one of the central areas of healthcare states.

Effective use of data across public health organisations (PHOs) is essential for the provision of health services. While health technology and data use in clinical practice have been investigated, interactions with data in non-clinical practice have been largely neglected. The purpose of this paper is to consider what constitutes data, and how people in non-clinical roles in a PHO interact with data in their practice.

This mixed methods study involved a qualitative exploration of how employees of a large PHO interact with data in their non-clinical work roles. A quantitative survey was administered to complement insights gained through qualitative investigation.

Organisational boundaries emerged as a defining issue in interactions with data. The results explain how data work happens through observing, spanning and shifting of boundaries. The paper identifies five key issues that shape data work in relation to boundaries. Boundary objects and processes are considered, as well as the roles of boundary spanners and shifters.

The study was conducted in a large Australian PHO, which is not completely representative of the unique contexts of similar organisations. The study has implications for research in information and organisational studies, opening fields of inquiry for further investigation.

Effective systems-wide data use can improve health service efficiencies and outcomes. There are also implications for the provision of services by other health and public sectors.

The study contributes to closing a significant research gap in understanding interactions with data in the workplace, particularly in non-clinical roles in health. Research analysis connects concepts of knowledge boundaries, boundary spanning and boundary objects with insights into information behaviours in the health workplace. Boundary processes emerge as an important concept to understand interactions with data. The result is a novel typology of interactions with data in relation to organisational boundaries.

Examining the self-identification of physician managers with their manager and clinician roles, and its impact on the state and professional powers in healthcare governance.

With purposive sampling, a total of 15 frontline clinical department managers (mainly principal consultants) and directorial managers (mainly Hospital Chief Executives) were recruited to elite interviews. The themes for data collection and analysis were based on a systematic scoping review of previous empirical studies.

Physician managers maintained respective jurisdictions in policymaking and clinical governance, as well as their primary self-identification as rationalizers or protectors of medicine, according to their managerial roles at a directorial or departmental level. However, a two-way hybridization of physician managers allowed the exchange of clinical and managerial authority, resulting in cooperation alongside struggles among medical elites; while some frontline managers were exposed to managerial values with the awareness of budget and organizational administration, some directorial managers remained aligned to a traditional mode of professional communication, such as persuasion through informal personal networks and by using clinician language and maintaining symbolic contact with the clinical field.

This study identifies the inconsistency in physician managers’ identity work, as well as its patterns. It goes beyond a dichotomized framework of professionalism versus managerialism or an arbitrarily blurred identity.